Your Expectations: Impact Day, UNAIDS, Geneva - March 29th, 2011

Best wishes to everyone. Whether you have been confirmed to attend the meeting on "Impact: Social and Behavioural Change" in Geneva on March 29th or will possibly be participating through this online network we would very much value your contributing in advance of the meeting responses to the following questions through this online facility. This will help to both:
(a) orient the presenters to your interests and expectations so that there presentations are even more valuable and
(b) allow us to fine tune the overall agenda relative to your expectations.

Please submit comments on the following:

What are two main concerns, issues, challenges or problems that your organisation faces related to the impact of social and behavioural change focused strategies and programmes on your priority issues?

What are the three main "things" you wish to take back to your organisation and work from the knowledge, insights, ideas and perspectives shared on March 29th?

Many thanks: advance dialogue, comment and conversation on these issues would be very helpful. (Please see the agenda previously shared for the overall meeting orientation).

One of my main concerns coming to this meeting is how to quantify, in an accessible way, the contribution of communication programming in relation to agreed national and international health and development targets. Below, I’ll focus on HIV prevention, but I think the same may go for polio, reproductive health and other areas covered in this meeting.

As a consultant to the Lesotho National AIDS Commission, I just finished working on the new Lesotho National HIV Prevention Strategy 2011-2015. This national prevention strategy, along with most others recently developed around Southern Africa, follows a results based format aligning with agreed national and international targets. My consultant team was tasked with developing the strategy, costing an operational plan, and recommending possible resources and organisations to implement it. While we knew what we wanted to achieve in terms of a measurable decline in HIV incidence, and the kind of combination of outcomes, outputs and inputs that may achieve this, we were really in the dark on how to quantify and cost the kinds of communication programming required to achieve the required results. This was in large part due to the fact that there was insufficient information available to us on the impact and costing of different communication approaches, particularly within the context of a generalised epidemic (where specific and more easily measurable projects for individual most at risk populations take different priority).

For example, we knew that one (from among several dozen) of our required outcome level results was an “increased percentage of population with comprehensive knowledge on the relationship between HIV prevention and multiple and concurrent partnerships”. In the strategy we documented the kinds of outputs required to achieve this, but we had no real method to quantify the intensity of programming required, the kind of geographical or population coverage that would be necessary, and the likely cost implications.

Those developing national level strategies are obliged to recommend evidence-based approaches, to use existing agreed national and international targets (for example Universal Access and PEPFAR targets), and to show a clear estimate of the relationship between funds allocated and likely results. This information is often not available for communication programming, or at least not in an easily accessed format. In practice, this meant that in Lesotho social and behavioural action could take second place to interventions where the relationship between outcomes and outputs is better understood and articulated (for example HIV counselling and testing, condom distribution, blood safety, male circumcision and universal precautions within clinical settings).

To cut off what could otherwise become a very extended entry, I’d say that one of my hopes for the meeting is that we come up with at least some first principles for developing an evidence base for communication programming that is accessible to those developing national strategies on HIV and other health and development issues. Listings of specific projects and their results among isolated sub-populations are not enough. We need a framework that allows for comparability and that relates to agreed national and international level goals (for example on HIV: PEPFAR targets, MGD goals and the related Universal Access targets). Recognising the complexities of the HIV epidemic and other health and development issues, and the need to work on various levels, including advocacy and social mobilisation, this evidence base would require some thought and an appreciation of extended causal chains linking inputs with national level impacts. But until some data exists that quantifies how specific communication interventions can contribute to agreed national targets, there is a risk that communication programming, for HIV at least, may be eclipsed by other more clinical or non-communication based methods. Establishing this evidence base (if that is what it should be called) is a big job, but could we put some basic principles or ideas in place to get it started?

We have been asked to outline three hopes for this meeting. I’ll stick with two. Seeing my first hope for this meeting as being rather ambitious, a second, more concrete one could be to strategise on how to continue gathering evidence for communication programming with the aim of submitting articles to the relevant academic journals. Working with Johns Hopkins in South Africa, we’ve already been invited by one journal to submit a paper that makes the case for communication for HIV prevention (adapting the advocacy piece that can be found at
http://jhuccp.org/node/1619
and also on the files section of this forum). With funds for communication being slashed, and senior decision makers questioning its efficacy, getting our results into the scientific and peer-reviewed literature is a big priority. Could we perhaps strategise on how to submit more papers?

Tom - thanks - really appreciated - an excellent insight - very helpful. We all look forward to the contributions from others outlining their expectations, general and specific, for the meeting on the 29th. To contribute please scroll to the bottom of this message - or the bottom of Tom's note - click on the link below Read More (then log in if you have not done so already), enter your Comment in the Reply/Comment box, scroll down past the participants list and click on Save. Using this approach we can all have a common, organised space for all contribuitons - thanks for participating - we look forward to everyone's contributions - best wishes - Warren

The main challenge that ORBIS is facing is to overcome barriers amongst the poorest of the poor to seeking care for eye problems and to make the decision to undergo sight saving surgery once they are aware that they or their children do not need to remain blind.

I wish to take back knowledge how other organizations/individuals/institutions have successfully managed; a. through diverse and combined approached to overcome barriers related to fear of medical interventions b. establish trust amongst the general population of a new service and c. ensured equal access to health care services for women/girls and men/boys.

Hi Warren,
The meeting is a great opportunity to learn from other practitioners, not only on the strategies and tools they used to achieve social change but also to get insights on their impact assesment methodology. I'm not directly involved in a behavourial change project. However, generation of knowledge and access to information is our core activity in order to bring change. I'm interested to learn more - in the context of moving from a diffusion model (stakeholders accessing information) to a behavourial one (internalization of key messages and 'good' practices leading to action) about the set of indicators we can implement to monitor that specific change (e.g., not tracking how stakeholders access the information but how they use it and what they do out of it). I'm sure I'll get ideas from the presentations that even if they're not directly linked to my field will inspire my practice.
Thanks for the opportunity
Sarah